Weight loss achieved through gastric-band placement resulted in type 2 diabetes remission in most patients participating in a small study. These results prompted a cautious suggestion that the surgery be considered for more widespread use.
A team in Australia evaluated 30 patients (mean BMI: 37.0) who underwent placement of a laparoscopic adjustable gastric band and 30 patients (mean BMI: 37.2) who underwent conventional weight-loss treatment centered on diet, exercise, lifestyle modifications, and, in some cases, medications. By the end of the trial, 22 of the 30 surgery patients (73%) achieved remission compared with only four in the conventional group (13%). Remission was defined as exceptional glycemic control—a fasting glucose level <126 mg/dL and a hemoglobin A1c value <6.2% while taking no glycemic therapy.
The surgery group also experienced significant improvements in insulin resistance as well as triglyceride and HDL levels. The reduction in the metabolic syndrome was significant among the surgery patients but not the conventional-therapy patients.
Nevertheless, the researchers pointed out that the degree of weight loss—rather than the method—appears to be the prime driver of glycemic improvement and diabetes remission in obese patients. “This has important implications, as it suggests that intensive weight-loss therapy may be a more effective first step in the management of diabetes than simple lifestyle change,” they wrote (JAMA. 2008;299:316-323).
Given the relative effects of surgical vs. conventional approaches, it may be time to regard bariatric surgery as an “intervention about which all obese patients with diabetes should be informed and given access,” wrote two American physicians in an accompanying editorial.